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It Takes a Village: Treating Adolescent Obesity Through True Collaboration

Shaina Eckhouse, MD, is a surgeon with a mission: to provide patients the greatest tool to fight the disease of obesity and achieve their weight loss goals.

According to the Centers for Disease Control and Prevention, obesity affects 1 in 5 children in the United States. Childhood obesity poses immediate and long-term health risks for children, including high blood pressure and cholesterol, breathing problems, mental health and social problems, and more severe adult obesity risks. Obesity increases a person’s risk of type 2 diabetes, obstructive sleep apnea, heart disease, stroke, fatty liver disease, kidney disease and other health issues.

The Weight Loss Surgery Program at Washington University School of Medicine in St. Louis offers bariatric surgery as an option for people with severe obesity who are unable to maintain weight loss through lifestyle changes. Patients in the Weight Loss Surgery Program receive expert care from Washington University physicians at the first accredited MBSAQIP (Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program) Center of Excellence for adolescent bariatric surgery in Missouri.

When Eckhouse joined the Section of Minimally Invasive Surgery at the School of Medicine, she knew that she wanted to extend the Weight Loss Surgery Program’s offerings to include adolescent patients.

A True Collaboration

“It’s not easy for teens with obesity to make the long-term lifestyle changes necessary to lose weight and maintain that loss over a lifetime,” Eckhouse recognizes.

Eckhouse partnered with Chris Eagon, MD, Director of the Weight Loss Surgery Program, and pediatric specialists from the Healthy Start Clinic at St. Louis Children’s Hospital, to offer weight loss surgery to adolescent patients between the ages of 15-18 years as an American College of Surgeons MBSAQIP-accredited Center of Excellence.

“Most accredited weight loss surgery programs are true collaborations,” Eckhouse says. “We are collaborative across the board—it’s not just Washington University School of Medicine; it’s also Barnes-Jewish Hospital, Barnes-Jewish West County and St. Louis Children’s Hospital. That collaboration sets us apart because we utilize those expertise on a daily basis to make sure our patients get the best care possible.”

The Adolescent Weight Loss Surgery Team, from left: Janis Stoll, MD; Ginger Nicol, MD; J. Chris Eagon, MD; Jennifer Sprague, MD; and Shaina Eckhouse, MD.

Patients and their families begin at the Healthy Start Clinic, where they meet with specialists, including Pediatric Gastroenterologist Janis Stoll, MD, Endocrinologist Jennifer Sprague, MD, PhD, and Psychiatrist Ginger Nicol, MD. To be eligible for bariatric surgery, an adolescent patient must have either a body mass index (BMI) of 40, or a BMI of 35 with a major co-morbidity, such as type 2 diabetes, obstructive sleep apnea or fatty liver disease. Specialists at the Healthy Start Clinic assess the patient’s health and help determine the best plan for treating their obesity.

For patients who choose to move forward with bariatric surgery, the next step is attending an informational seminar.

“We believe that true collaboration means educating our patients,” Eckhouse says. “Weight loss surgery is a big change. Your stomach is changing size. Your relationship to food is changing drastically. During our information seminars, we want to help prepare patients for these changes. We give our patients all the information we have, because if they don’t know what we know, we’ve done them a disservice.”

At this seminar, the patient learns more about surgical procedures, weight loss, insurance coverage and the surgeons performing these procedures. Traditionally, these seminars have been held in-person at Barnes-Jewish Hospital or Barnes-Jewish West County Hospital. The Weight Loss Surgery Program has recently added online options—including live Zoom meetings and a recorded online seminar—for convenience and safety.

Prior to surgery, the adolescent patient undergoes six months of medically supervised weight loss, meeting regularly with specialists at the Healthy Start Clinic. This helps establish realistic weight loss goals and develop sustainable lifestyle changes.

“Patients—whether adult or adolescent—tend to do better when their family unit is supportive,” Eckhouse emphasizes. “For children, this is especially important, because it is the parent who is in control of what food is on the table. What do we do after school? Play outside, ride a bike or watch TV? The outcomes are better when we align expectations, make sure the family is on board and that the proper social support system is in place for the child going through the process. The entire family must be on board and willing to work towards their child’s success.”

It Takes a Village

“There’s that saying: ‘It takes a village.’ I happen to be part of an incredible village,” Eckhouse says.

That village includes Bariatric Data Coordinators Dawn Freeman and Tina Ducharme, Bariatric Coordinators Angela Britt and Antoinette Falker, Nurse Practitioner Jayme Sparkman, Nurses Ashley Waldrop and Ashley Welborn, and Administrators Katie Guethle, Shannon Adams and Joanie Linenfelser. The team at the Healthy Start Clinic help educate and prepare patients for this life-changing surgery. The whole Weight Loss Surgery Team contributes to the program’s innovations and improved patient outcomes.

“At the School of Medicine, we are able to offer procedures to patients with atypical medical problems or complicated surgical histories, including former weight loss surgery patients looking to lose more weight,” Eckhouse says. “We’re able to offer a high standard of care and a level of creativity that meets the needs of our patients. That’s why I love working at Washington University: our team is very encouraging of creativity. When I joined the faculty, I added the duodenal switch to our procedure offerings. Francesca Dimou, MD, MS, added robotic techniques.”

Eckhouse is also proud to work alongside her mentor, Chris Eagon, MD, who began performing bariatric surgeries at Barnes-Jewish Hospital in 1997. Eagon earned his medical degree from Harvard University and completed his General Surgery Residency at Washington University School of Medicine. He also received fellowship training in digestive diseases at the Mayo Clinic and in medical informatics at the University of Utah.

“He’s the man, the myth, the legend that is bariatric surgery both locally and nationally,” Eckhouse says. “With Dr. Eagon’s expertise, the Weight Loss Surgery Program offers procedures to patients who may not have been eligible elsewhere. You don’t find this level of offerings at other institutions. For example, our team is able to offer procedures to patients with liver or kidney failure, patients with a BMI too high for them to have transplant surgery. We help as many patients as we can.”

Eckhouse’s village is growing, as she continues to educate fellow surgeons, general surgery residents and medical students.

“My favorite moments of my career have been watching residents perform a gastric bypass,” Eckhouse states. “I could name every resident I’ve assisted with this procedure, because each one is such a proud training moment for me. It is very rewarding to see residents develop the techniques they need to do the procedure efficiently and with skill. I really enjoy watching them succeed and excel in this advanced laparoscopic procedure, whether they are going to pursue a specialty requiring that expertise or not.”

The Art of Science, the Science of Art

Eckhouse completed a minimally invasive and bariatric surgery fellowship at Duke University Medical Center. She also completed a general surgery residency at the Medical University of South Carolina in Charleston and earned a medical degree at the University of Texas Health Science Center in San Antonio. Her passion for science stretches back to childhood, but at one time Eckhouse considered pursuing a career in the arts.

“If I hadn’t become a surgeon,” Eckhouse muses, “I would probably be working in a museum or art gallery.”

As an undergraduate, Eckhouse minored in art and art history—she was a few short credits away from a double-major. Despite her busy schedule, Eckhouse still loves to sketch, paint and practice photography today.

“I like the smell of the darkroom,” Eckhouse says. “I like film, seeing the pigments on watercolor paper. In college, I had a sort of existential crisis. I wasn’t sure if I wanted to pursue medicine or something in the arts. I didn’t know it at the time, but now I realize how much art is involved in surgery. Every body is different. You have to be creative and adaptive to care for every patient in a way that fits their body, their situation. There’s an art to science. And there is science in art: depicting accurate anatomy, getting the right proportions in a face.”

In addition to providing bariatric surgery to adult and adolescent patients, practicing her artistic pursuits and educating future surgeons, Eckhouse is renovating her St. Louis home with her engineer husband.

“Every resident, CRNA, anesthesiologist and surgeon at Washington University knows that I don’t have a kitchen,” Eckhouse says. “My husband redid all of the plumbing and electrical work in the house. We have walls, but not floors. We could have hired someone, but our approach is to just do it ourselves. The top floor is scary right now, but the plan is for me to have an office up there. That’s where I’ll set up my easel.”

Shaina Eckhouse, MD

Eckhouse’s creativity shines through, whether in her approach to unique clinical cases, training opportunities or home renovation projects. She and her colleagues in the Weight Loss Surgery Program and Healthy Start Clinic look forward to providing the best quality of care to all patients at St. Louis Children’s Hospital, which U.S. News and World Report ranks among the best children’s hospitals: number 1 in the state of Missouri and among the top 10 percent nationally.